Oral Isotretinoin
Oral isotretinoin suppresses sebum secretion, inhibits cell proliferation, inhibits bacterial proliferation, controls the formation of microcomedones, normalizes keratinization and reduces the formation of lesions and comedones, and it may have anti-infammatory effect (44, 45). In patients whose acne is severe and refractory to oral antibiotics, COCs, and spironolactone, isotretinoin use should be considered (42). Isotretinoin treatment may be beneficial in patients with severe cystic acne who are not able of using COCs (46).